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Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis

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Luis Ayerbe, Ivo Forgnone, Quintí Foguet-Boreu, Esteban González, Juliet Addo, Salma Ayis

Original languageEnglish
Article numberPSM-D-17-00691R1
JournalPsychological Medicine
Early online date1 Mar 2018
StateE-pub ahead of print - 1 Mar 2018


King's Authors


Background: The high cardiovascular morbidity and mortality reported for patients with psychiatric disorders may possibly be due to a poorer management of cardiovascular risk factors. However, these healthcare disparities remain poorly understood. In this paper, studies comparing the management of smoking, diabetes, hypertension, and dyslipidaemia, in patients with and without depression, anxiety, schizophrenia, bipolar, or personality disorder, were reviewed. Methods: Prospective studies comparing rates of screening, diagnosis, treatment and control of cardiovascular risk factors, were searched in PubMed, Embase, PsychInfo, Scopus, and Web of science (inception to January 2017). The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used. Studies were assessed for quality. Wherever possible, metanalyses were conducted to summarise the findings. Results: Twenty studies, out of the 18333 references initially identified, were included. Most studies were heterogeneous in design. Two areas permitted metanalyses: the pooled OR for quitting smoking for those with depression, was 0.64(0.49 - 0.80) p<0.001; the pooled difference of glycated haemoglobin for patients with Type II diabetes and depression was 0.18(0.06-0.31) p=0.005. Individual studies showed associations between: schizophrenia and lower probability of having smoking habit recorded; schizoid personality disorder and higher probability of remaining non-smokers after quitting; anxiety and poorer control of Type I diabetes; depression, anxiety, or schizophrenia and lower probability of having a diagnosis of hypertension; schizophrenia or bipolar disorder and lower use of antihypertensive and lipid lowering drugs. Conclusions: A proactive clinical management, together with further studies, are needed to reduce the cardiovascular morbidity and mortality of patients with psychiatric disorders.

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